Category: Professional Posters
Purpose: In 2017, the US Department of Health and Human Services officially declared the opioid crisis affecting the United States a public health emergency. Opioid Stewardship programs are being instituted at acute care facilities across the nation to reduce inappropriate opioid use and increase the utilization of non-opioid alternatives to treat pain. As part of our facility’s opioid stewardship program we examined the use of intravenous hydromorphone across twenty two standalone City Hospital Emergency Care Centers in the Dallas and Fort Worth areas in Texas.
Methods: A retrospective chart review was completed for patients who received intravenous hydromorphone at any of the 22 City Hospital Emergency Care Centers across Dallas- Fort Worth area. Data collected include amount of hydromorphone given, prescribing physician, indication for use, date, and location. A complete medication background was also performed for each patient through the Texas prescription monitoring program, to identify any discrepancy or suspicion of multi-prescribers, and multi-pharmacy use for control medications. The time frame for the retrospective review was from March 1, 2019 to March 31, 2019.
Results: In March 2019, a total of 152 hydromorphone doses were given to 132 patients across 22 City Hospital Emergency Care Centers. Twenty percent of the hydromorphone doses were administered at the Fort Worth-Bass location; followed by 12 percent of the total doses given at Garland location and Mesquite-Beltline road location. The main reason documented for the administration of hydromorphone was abdominal pain (44%), followed by 21% due to injury. Other reasons for hydromorphone administration were due to genitourinary pain, chest pain, chronic pain, acute pain due to illness, headache, migraine, and acute exacerbation of chronic pain.
A complete medication background was also performed for each patient through the Texas prescription monitoring program (PMP). Out of 132 patients, 16 patients were given 2 or more doses of hydromorphone at the same visit or in the same day. Eight patients were found with a history of obtaining controlled medications from multiple prescribers and multiple pharmacies. Six patients were identified with higher than normal 30 days average morphine milligram equivalents (MME)/day level, which is < 50 MME/day. Nine patients were prescribed CII pain medications following their visit.
Conclusion: Based on the results of this review, we now know how much hydromorphone was used at each location in one month. To reduce the utilization of hydromorphone we are proposing a specific protocol for hydromorphone use in our Emergency Care Centers, which should include a pain severity scale. In addition, we also recommend education for healthcare providers on alternative analgesic medications and procedures as well as a patient screening via Texas PMP prior to administering pain medication or prior to writing discharge prescriptions for controlled substances.